Episiotomy... should I be concerned about mine? (tmi)

[ALovelyBunchOfCoconuts]

I gave birth to DS just over two weeks ago, and after a prolonged second stage I had to have an apisiotomy and forceps delivery. I had Neville-Barnes forceps so not too high up thankfully. (This is my second episiotomy, 1st birth 3.6years ago, ventouse)

When i was in recovery i had to be resutured as some stitching had come undone and they also had to put in some more individual ones after seeing some extras that needed doing. I was therefore given a weeks worth of ABs.

For the first week I was a little sore and tender but nothing too bad but as I hit the week mark the stitches became really tight and itchy and painful - I presume this was just part of the healing process.

Now I am at the two week mark, the stitches feel alot easier and I don't really know they are there tbh and I felt brave enough to have a look and also a feel while I was in the bath.

I was shocked to find the stitches extend right up inside my vagina, from my perineum, as far up as I could reach. The whole of the back wall of my vagina has been sewn together. Is this normal for them to go that far in/up? I don't recall my first episiotomy going that far? The stitches inside feel really tight and I'm really concerned about the cut being too long? Also, after wiping the other day there was actually some thread/cotton on the tissue that had clearly come out of me. Is this normal?

I know it's only been two weeks and I should still expect them to not be fully healed yet but is it common for an episiotomy to extend that far?

I have obviously been discharged from the MW now so any problems I have will have to be looked at by my GP. I am reluctant to go if I don't really have to, I feel a little embarrassed now. So many people examined me during my labour, I kind of feel like I just want to get my privacy back now, so I really hope someone can tell me all sounds normal :)

Hiya, I don't know about how far up they cut the episiotomy but it is very easy for the episiotomy to tear a bit further, and I've heard of other people having internal stitches. It is normal for the stitches to fall out as they are sewn with dissolvable thread, so they may fall out over time.
I only had external stitches for a 2nd deg tear but i was sitting on a ring cushion for two weeks and the midwife pulled out some undissolved stitches at two weeks, which made everything much more comfortable. So it sounds like you are healing well. Don't worry if you don't feel back to normal for several months. Ask the gp to check you at 6 weeks, but really the healing process can go on for 6months or more. It sounds like you got good care at the time of the birth, with them stitching you carefully so hopefully they've done a good job and everything will heal nicely.

bump

Hi, sounds exactly like what happened to me, it said extended episiotomy on my notes but I had no idea what had actually happened as the midwife who delivered DS finished her shift as I was being stitched up and the doc left as soon as she'd finished so I kind of had to figure out for myself what the damage was and I was shocked to find I had been stitched so far up (like yourself it took a while to feel brave enough to feel in the bath). I did feel tight as it was healing and big bits of stitch would come out in the bath or on toilet tissue so don't worry about it, sounds like it is healing very well.
Just one tip though, make sure you're seen by a female GP at your 6 week check up, I was booked in to see a male GP for mine and he wouldn't look and told me to make another app with a female GP! What peed me off was it was the bloody doctors that phoned to tell me it was time for my 6 week check and they booked it with a male doc, I'd assumed he'd want to look and see everything was healing OK but I think the 6 week check is just so they can tick a box and ask what contraception you've considered.
All in all I found post natal care to be very poor, you're pretty much on your own as soon as you've delivered.

jamesmum - how long ago was yours done? is it ok now?

i will try and book with a female dr, thanks for that :)

my notes never said extended and i asked the dr when he was stitching me if it was big and he said no very small

Hiya. Ds is 8 weeks now and I had a forceps delivery (Kielland?s). When I was having a 'poke' a few weeks ago I realised that I'd been internally stitched, right up to where my cervix is. The only things I've read about episiotomy's and stiches refer to tears going the other way! I'm asuming I just tore from the forceps where the epsiotomy had weakened the skin/muscle.

DS is 18 weeks now and mine had healed up nicely well before the 6 week check ( just wanted it looked at for peace of mind really as it seemed such a big thing to me). I even managed to "do it" at about 5 weeks! ha sorry if tmi, but it was more to see if I still could, once it was in I was like "right, get off now" :)
The fact your DR said it was small just goes to show what they are used to dealing with day in day out, big deal to us but run of the mill to them.

Thanks both :)

yes I did think that if the dr said it was small then perhaps I shouldn't be worried. It just seems so much bigger than the one I had with DD.

glad to hear yours healed so quickly jamesmum :) and relieved to hear that you managed to DTD so soon. I have been terrified since feeling it that I'll be out of commission for all eternity!

hiss Same here, everything I read says about tears going in the opposite direction, although Keillands do go far higher than neville barnes so it would definitely sound as though thats whats happened with you. are your healing well?

Hi

Yep - very normal. An epis normally involves the posterior vaginal wall (bit that runs along the back passage) and down into the perineum. It can be quite hard to visualise this: when I started my midwifery training I couldn't
see how one cut could involve both parts of the anatomy but the head when delivering, kind of flattens the vaginal wall. It's the only way I can describe it. The extent of trauma does depend on when the epis is done, whether it extends and whether there has been any trauma prior to the epis. Hope that helps a bit - it is hard to visualise/explain.

At this stage I would expect the stitches to start dissolving so would anticipate the bits of suture you describe. Keep doing those pelvis floors - one if the best things for healing.

Hi Laluna, thanks for that, you described it really well and thats the first time I've properly understood whats happened down there! Do you think it could heal well enough to stretch normally in subsequent deliveries? I have it in my head that I would inevitably need an epis next time, though I was cut right at the very end of second stage just as I was almost there (a kiwi suction cap was used) so I guess things had already stretched a fair bit!
Sorry for hijacking your post lovelybunch

Jamesmum

I have seen many subsequent deliveries after previous ones with an epis which have resulted in no stitches at all! Generally, that area can be very forgiving - a rich blood supply means things heal well and the vaginal tissue is designed to stretch!